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Definitive treatment of midfacial fractures
Dr.Mohamed Rahil(Maxillofacial surgeon)
Tikrit dentistry college
Priority to saving patient life (ABC)
Principle of treatment Reduction FixationImmobilizationFollow up and
rehabilitation
Dentoalveolar fracture
I. Fracture of teetha. Fracture of teeth without pulp exposureb. Fracture of teeth with pulp epxosurec. Subluxationd. Avultion II. Fracture of alveolus and maxillary tuberosity
Zygomatic complex fracture
Indications for reduction• Diplopia• Restriction of mandibular movement• Restore orbit skeleton• Restore normal contour of face
Reduction
• Time
• Appraoches
Gillies approach
Keen approach
Quinn approach
Percutaneous approach
fixation• Trans-osseous wiring
plating
Fixation with pack in the maxillary sinus
• Comminuted fracture of zygoma• Comminuted fracture of orbital floor
• Ballon or back can be used
Pin fixation
• Excessively mobile zygoma• Following surgical refractur of badly displaced
zygomatic bone which has been healed
Fracture of zygomatic arch
• Reduction through Gillies approach• Fixation un necessary in recent fracture
Fracture of orbital floor
Indications for treatment
• Diplopia not resolved after 10 days after injury• Large herniation of tissue to the antrum• Restriction of eye globe movment• Enophthalmus greater than 3 mm
Nasal complex fracture
• Reduction
Walsham’s forcepsAsche’s forceps
fixation
• POP • Lead plate splint• Open reduction
LeFort fractures
Le Fort I fracture
Rowe’s disimpaction forceps
Lefort II
Lefort IIIUsually multiple fractures Priority of treatment ;
Reduction of zygomatic bone fracture
Teeth bearing portionNaso-ethmoidal fractureAnd finally nasal complex
immobilization
Immobilization of lefort fractures
• Extra-oral immobilization
• Immobilization within the tissue
Extra oral immobilization
• 1. cranio-mandibular • A. box frame• B. halo frame• C. pop headcap• 2. craniomaxillary • a. supra – orbital pins• B. zygomatic pins• C. halo fram• 3. suspension
Immobilization within the tissues
1. Direct fixation• A.Transosseous wiring• B. K-wire• C. plating 2. internal wire suscpension 3.support
Type of plating
• Minplate• Compression plate • Reconstruction plate
Rigid fixation VS non rigid fixation
Complications of fractures
• Complication from head injury• Complications from fracture it self• Complications associated with lacrimal
system• Ophthalmic complication• Complications from neural damage• Non - union
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